Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative "555 Technique"

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 27; no. 3; p. 295
• Main Authors: Gupta, Manish K, Muley, Kiran Kumar, Bethanbhatla, Murali Krishna, Nanavati, Juhil D, Manish, Kumar, Sarangi, Rathindra
• Format: Journal Article
• Language: English
• Published: United States 01.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Hernia, Inguinal - surgery; Herniorrhaphy - instrumentation; Herniorrhaphy - methods; Humans; Laparoscopy - instrumentation; Laparoscopy - methods; Male; Middle Aged; Peritoneum - surgery; Treatment Outcome; extra peritoneal repair without Hasson trocar; mini TEP repair of inguinal hernia; 555 Technique of inguinal hernia repair; Manish Retractor; TEP repair without Hasson trocar; 555 Technique
• ISSN: 1557-9034
• DOI: 10.1089/lap.2016.0462

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports. Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years). Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients. "555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.